Player Contact Information

Player's Name: (first) _____________________ (last) _______________________

Date of Birth: (day) ____ (month) ____ (year) ____    Current Age: ________

Address:       _______________________________________ (apt#) _____________

City/Town:     (city) ____________________________ (postal code) __________

Phone:   (home) (___)_________  (work) (___)_________  (FAX) (___)_________

Email:   _____________________

Height (feet/inch): ___________________  Weight (lbs):  ___________________


If player is under 18, Parent/Guardian's Name: ____________________________

                      Parent/Guardian's Phone: (____)______________________

General Information

Hockey Shirt Size (check one):
   Adult S ________ M ________ L ________ XL ________ XXL ________
   Youth YS _______ YM _______ YL _______ YXL _______

Sweater Number:
   1st choice ________  2nd choice ________  3rd choice ________

Do you have any friends who want to play roller hockey?
  (1) Name:  ____________________________
      Phone: (____)______________________
  (2) Name:  ____________________________
      Phone: (____)______________________

Please give us info on people who could coach/manage a team:
  (1) Name:  ____________________________
      Phone: (____)______________________
  (2) Name:  ____________________________
      Phone: (____)______________________

Hockey Experience

Do you play hockey?   Yes _________  No _________
If Yes, Number of years _________

Have you ever played roller hockey?  Yes _________  No _________
If Yes, Number of years __________

Position(s) played:                F _______ D _______ G _______
Position desired in roller hockey: F _______ D _______ G _______

Level(s) of Ice Hockey played:
   House _______ Select _______ A _______ AA _______ AAA _______ 
   Adult _______ University _______ Other ______________________

Curent Ice Hockey team (if any): _______________________________

Waiver

The applicant agrees that the Metro Toronto and Region Roller Hockey League and/or its Proprietors will not be held responsible for any accident or loss however caused, and agrees to release the Proprietors from all claims or damages which may arise as a result of such accident or loss. In the event of inability to contact me, I hereby give you permission to seek out any necessary medical assistance I or my child may require while attending the roller hockey program. The applicant agrees to abide by all stated and written rules and regulations of the game or roller hockey as administered by the Metro Toronto and Region Roller Hockey League. The applicant agrees to abide by the rules of the referees and coaches involved in the program. The applicant agrees to participate in the spirit of good sportsmanship at all times.

_______________________________________________________________
Name (Parent or Guardian)

_______________________________________________________________
Signature (Parent or Guardian)

_______________________________________________________________
Signature (Applicant)

_______________________________________________________________
Date

Note: Helmet (full face mask or visor) is required for all players under 18 years. Half visor is recommended for adults. Since the game is non-contact, no upper body equipment will be needed.

Application Information

The registration fee is $100 Canadian funds, payable by cash, certified cheque, or money order to MTRHL. For more information, please contact CIRSA.

Please print this form, complete it, and mail it with the registration fee to:

CIRSA
679 Queens Quay West, Unit 117
Toronto, Ontario
M5V 3A9

The women's league will play games every Sunday night, except for the long weekends, throughout the summer. The games will run between 6pm and 9pm on Sunday night at the North York Centennial arena. Three teams from the league will travel to the North American Roller Hockey Championship in Vancouver in August 1997.